Children's Hospitals Make Room for Mom, Dad and Diversions

Children's hospitals are spending heavily on new building and renovating as the first ever set of guidelines setting standards for children's facilities is about to be issued. Laura Landro and Nationwide Children's Hospital CEO Steve Allen join Lunch Break with details. Photo: Nationwide Children's Hospital.

By

Laura Landro

Jan. 14, 2013 6:38 p.m. ET

For parents, having a child in the hospital is stressful enough, but the physical environment can make things worse: noisy halls, shared rooms, a single cramped recliner in the corner to grab some sleep.

Now, children's hospitals are transforming their approach to care, replacing outmoded facilities and adopting family friendly policies to make an often-painful experience less traumatic for parents and children.

Next year, the first guidelines specifically for new construction and renovation of children's hospitals are set to go into effect. These voluntary—though influential—guidelines were developed by the Facilities Guidelines Institute, a nonprofit group that helps set standards used by federal agencies and most states to regulate the design and construction of health-care buildings. They include a recommendation to scrap shared patient rooms in favor of spacious private rooms, sleeping arrangements for parents such as convertible sofa beds and noise-reducing materials.

Nationwide Children's Hospital in Columbus, Ohio, has a 'Magic Forest' in the main lobby. Here, Daniel Rako, 15 and his mother, Jill Rako, in the lobby.

More on the Littlest Patients

Hospitals are convening family councils to provide input on their needs and hiring museum architects to design therapeutic gardens and interactive play spaces.

Funding for such projects comes from generous private donors, cash generation from hospital operations and new bond financing, as well as government grants. Hospitals say families won't see any of the renovation costs in their bills.

In Columbus, Ohio, Nationwide Children's Hospital opened a new $783 million tower last June with all private rooms, a whimsical atrium filled with giant carved animals, a clubhouse for patients' siblings and room service for family members. The same month, Chicago's 130-year-old Children's Memorial Hospital closed its doors and transported patients by ambulance to the new $855 million Ann & Robert H. Lurie Children's Hospital of Chicago. In addition to private rooms, it has a CT scanner that resembles a yellow submarine and an outdoor rooftop garden to help patients and parents get a break from treatment.

For the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., which is opening a new $257.5 million wing next year with a five-story atrium, architects designed "neighborhoods" of four to eight private rooms to reduce the distance staff has to travel and to improve communication. The new rooms will each have a refrigerator, closet space and two TVs so parents and children can watch separately. The hospital will also offer laundry facilities, concierge services and interactive play spaces for kids.

"It's tough to come to the hospital, which [children] associate with anxiety and pain," says Chief Executive
Kevin Churchwell.
"Our goal is to at least create an environment they don't mind coming to which might have a 'wow' factor to kids."

In a 2008 report on the effect of the physical environment on children in health-care settings, The Children's Hospital Association and the Center for Health Design warned that hospitals "can no longer tolerate subjecting patients to noisy, confusing environments that create anxiety and stress." In a review of more than 300 studies they found that steps such as noise reduction can help reduce anxiety and distress, while interior-design elements such as color, furniture and carpet can promote healing.

The changes were inspired by a growing movement known as family centered care. In addition to offering a safe and soothing environment, it calls for allowing families to be present and involved, including during invasive procedures and doctors' morning teaching rounds. The physical changes are costly, and more family participation may disrupt traditional staff practices.

However, a small but growing number of studies show family involvement in hospitals can help speed recovery and shorten stays, increase satisfaction and even reduce malpractice claims, potentially cutting costs.

Safety data incorporated into guidelines for adult care are also being taken into account. For example, private rooms, adopted as a standard for new hospital construction in 2006, have been shown to reduce the spread of infection and decrease the disruption of sleep, an important factor in healing. And special patient lifts and bathing fixtures to prevent falls and injury for obese adults are also a growing need for children.

"This is a landmark effort to apply the same research and evidence for children's hospitals as we do for adults, and recognize the issues of families," says
Judy Smith,
a consultant who led development of new children's-hospital guidelines for the Facilities Guidelines Institute. This nonprofit, whose work originated in a postwar federal program, is now overseen by architects, builders and clinicians who created the children's hospital guidelines as part of an update of general hospital guidelines from 2010.

After public comments on the guidelines are reviewed, a final version is due to be published next year by the American Society for Healthcare Engineering. Although the guidelines are voluntary, they are expected to be widely used by states and accrediting groups in approving plans for new construction and renovation.

Steve Allen,
CEO of Nationwide Children's, says clinicians are increasingly coming to accept that it is important to keep families comfortable and let parents be present 24/7 if they want to be. The hospital, which is also a pediatric trauma center, allows parents to be present even for resuscitation after shock or trauma. It has worked with family council members to determine where the family should be positioned during those procedures to avoid interference, while keeping them fully informed.

"It's hard for some people to get their head around the fact that it is OK to have the parents in there, even if the child is near death, but we are providing care for the entire family, not just a sick child," Dr. Allen says.

Jill Rako
is all too familiar with the discomforts of children's hospitals: Her 15-year-old son Daniel, born with spina bifida, the incomplete development of the spinal cord, has logged dozens of surgeries and stays at Nationwide Children's. Although she says the care was excellent, for long-term stays the environment was "a nightmare." The hospital asked her to be part of the family council several years ago. Among her suggestions: more space and privacy, comfortable sleeping accommodations and a decent bathroom for parents whose kids are "frequent fliers," those often hospitalized for weeks at a time.

Still, she says, the family was awe-struck when they came to check in for surgery at the completed facility last April, ahead of the official opening. They found a spacious private room with a pullout sofa bed, a family bath and large flat-screen TV.

The hospital has created an environment that isn't only conducive to healing, she says, but makes it easier for her to keep up with her own work as a project manager via wireless Internet in the rooms. And she never misses a visit from doctors or nurses because she doesn't have to go down the hall to use a communal shower in a family lounge. She even jumped out of the shower when her son's surgeon came into the room, talking to him with dripping hair. "I can handle just about anything with clean hair and a good night's sleep," she says.

Melanie Ide,
an architect at New York-based Ralph Appelbaum Associates who led the Nationwide project design, says she drew on her experience working with museums to create public spaces that would provide a delightful experience while helping families find their way around. That led to color-coded paths, a Magic Forest in the main lobby and a wishing tree where family members can write their hopes for hospitalized children.

When she was consulting with hospital staff in her research, Ms. Ide says, she was most inspired by a nurse who said "her day is made when she can make a kid smile through the tears."

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